This article was published originally on Nutrition at UNC-CH & Translational Science.

By Kaylee Helfrich

December 12, 2018 – If you’ve ever been around a pregnant woman, you’ve probably heard her mention something about food cravings. Or she’s mentioned that she won’t drink coffee or eat Oreos because they are “bad for the baby.” Food is a hot topic during pregnancy because of how it can drastically affect the developing baby. But how many times have you heard a woman mention that she is eating healthier because she is going to try to get pregnant?

Recent studies have increased interest in preconception nutrition, which is the woman’s nutrition in the weeks to years before she starts trying to get pregnant.  This is an important topic, because most women around the world do not or cannot achieve adequate nutrition- 50% of women are anemic and more than 120 million women are underweight, and many other deficiencies are also common. Understanding and then implementing preconception nutrition is essential, because a woman’s nutritional status before she becomes pregnant greatly influences the health of her growing child. Furthermore, a woman’s nutritional status can greatly affect how she feels during pregnancy and how easily and safely the pregnancy progresses for her.

How does preconception nutrition affect pregnancy? Most cells in the body need enough nutrients (such as vitamin B9, vitamin D, calcium, and others) to function properly. This is especially true for gametes, which are the cells that form the baby (the egg from the mom and the sperm from the dad). These gametes have one of the most important jobs in the body, which is to pass a parent’s genetic material on to a child. This means that it is essential that these cells are healthy. Adequate maternal nutrition is also very important for the early development of the placenta, which is the organ that passes nutrients and oxygen to the growing baby from the mom.

What nutrients are the most important to optimize prior to attempt to become pregnant? Although all nutrients should be optimized prior to pregnancy (ideally through a balanced diet) some nutrients are even more important than others. These nutrients are especially important for the woman to consume; this is because the nutrients are either difficult to get (even with a balanced diet), or because it is so detrimental to the baby if the mother doesn’t get enough of these nutrients before pregnancy. Many of the necessary nutrients are found in fruits and vegetables, and 77% of women do not get enough fruits and vegetables in their diet.

Folate: This is one of the most important nutrients to optimize prior to pregnancy because of how bad it can be if folate is not sufficient. Insufficient folate increases the risk of neural tube defects(which involve improper formation of the brain and spine), preeclampsia, miscarriage, low birthweight, and stillbirth. Folate is important to optimize before pregnancy because folate is needed during the first two months of pregnancy, often before the woman knows that she is pregnant. Certain foods are a good source of folate, including peas, beans, lentils, asparagus, eggs, and leafy green vegetables.

Iron: Many women around the world are iron deficient, even before pregnancy, and pregnant women are even more prone to iron deficiency. A woman needs large iron stores to support the growing baby, her expanded blood volume, and blood loss at birth. Without enough iron during early pregnancy, the baby may not have enough iron in their brain, which can lead to cognitive deficits that last through the lifetime.  Some examples of foods that are rich in iron include shellfish, spinach, liver, beans, peas, lentils, and red meat

Choline: Choline plays a lot of important roles in the body, but it is especially important during early pregnancy for proper brain development and avoidance of neural tube defects. Some examples of foods with a lot of choline include eggs, meat, cruciferous vegetables, and peanuts.

Zinc: Zinc deficiency early in pregnancy can prevent neural tube closure and inhibit proper development of the placenta and child. Some foods are a good source of zinc, including meat, shellfish, beans, peas, lentils, nuts, and dairy.

Healthy weight: A healthy weight is very important to establish before trying to get pregnant. Around the world, 10% of women weigh too little, and a woman who weighs too little can face difficulties such as preterm birth and low infant birth weight. Weighing too much can also be a problem, and the percent of women weighing too much during pregnancy is increasing, with 15% of women around the world weighing too much. This number reaches as high as 50% of women being overweight or obese in some countries. Overweight and obesity can cause pregnancy complications such as the inability to become pregnant, gestational diabetes, preeclampsia, a difficult birth, and even a stillbirth. Luckily, attaining a healthy weight prior to pregnancy can allay some of these issues. For example, a recent study found that using bariatric surgery to help with weight loss can improve pregnancy outcomes.

The nutrients discussed here are not the only nutrients needed for a healthy pregnancy, but they are some of the most important nutrients and/or some of the most likely nutrients for women to be lacking when entering a pregnancy. The importance of preconception nutrition is clear considering that 75-95% of women in the United States enter pregnancy with a sub-optimal diet.  It is important that all women of childbearing age try to maintain a healthy diet, not only for their own health but also for the health of the next generation.

Kaylee Helfrich is a PhD student in the laboratory of NRI deputy director Susan Smith, PhD. Her research focuses on how prenatal exposure to alcohol alters fetal iron metabolism. Kaylee writes regularly for the UNC-CH Nutrition Department blog NUTS on subjects of human nutrition and related science.

Post: December 12, 2018